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Article 33 215Chiropractors

PART 1GENERAL PROVISIONS

12-33-101 12-215-101. Legislative declaration - unlawful acts - license required.12-215-102. Applicability of common provisions.12-33-102. 12-215-103. Definitions.12-33-103. 12-215-104. State board of chiropractic examiners - subject to termination -

repeal of article - board meetings - election of officers.<{Recommend combining 12-33-103 and 12-33-105 intosingle section, 12-215-104.}>

12-33-104. Oath. (Repealed)12-33-105. Board meetings - election of officers. <{Consolidated with

12-33-103 and moved to 12-215-104.}>12-33-106. Bond. (Repealed)12-33-107. 12-215-105. Board powers - limits on authority - publications - records.

<{Recommend combining 12-33-107, 12-33-107.5, 12-33-108,& 12-22-110 into single section, 12-215-105.}>

12-33-107.5. Limitation on authority. <{Consolidated with12-33-107, 12-33-108, & 12-33-110 and moved to12-215-105.}>

12-33-108. Board publications. <{Consolidated with 12-33-107,12-33-107.5, & 12-33-110 and moved to 12-215-105.}>

12-33-109. Disposition of fees. <{Recommend repealing as redundantwith fees common provision.}>

12-33-110. Records. <{Consolidated with 12-33-107,12-33-107.5, &12-33-108 and moved to 12-215-105.}>

12-33-111. 12-215-106. Licensure - minimum education requirements.12-33-111.5. 12-215-107. Display of license required.12-33-112. 12-215-108. Application for license - fee - examination.12-33-112.5. Temporary licensure. (Repealed)12-33-113. 12-215-109. Licensure by endorsement.12-33-114. 12-215-110. Renewal of license.12-33-114.5. 12-215-111. Change of address - reporting required.12-33-115. 12-215-112. Persons licensed under previous laws.12-33-116. 12-215-113. Continuing education.12-33-116.5. 12-215-114. Professional liability insurance required.12-33-117. 12-215-115. Discipline of licensees - letters of admonition, suspension,

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revocation, denial, and probation - grounds.12-33-117.5 12-215-116. Mental and physical examination of licensees.12-33-118 12-215-117. Use of title.12-33-119 12-215-118. Disciplinary proceedings.12-33-119.1 12-215-119. Professional review committee - immunity.12-33-119.2 12-215-120. Cease-and-desist orders.12-33-120 12-215-121. Unauthorized practice - penalties - exemption.12-33-121 12-215-122. Judicial review.12-33-122 12-215-123. Duty of district attorneys - duty of department of regulatory

agencies.12-33-123. Application of article. (Repealed)12-33-124 12-215-124. Professional service corporations, limited liability companies,

and registered limited liability partnerships for the practice ofchiropractic - definitions.

12-33-125 12-215-125. Reporting requirements.12-33-126 12-215-126. Confidentiality - exceptions.12-33-127 12-215-127. Animal chiropractic - registration - qualifications - continuing

education - collaboration with veterinarian - discipline - titlerestriction - rules.

12-33-128 12-215-128. Chiropractic assistants.

PART 2SAFETY TRAINING FOR UNLICENSED X-RAY TECHNICIANS

12-33-201 12-215-201. Legislative declaration.12-33-202 12-215-202. Board authorized to issue rules - definition.

PART 1GENERAL PROVISIONS

12-215-101. [Formerly 12-33-101] Legislative declaration - unlawful acts -1license required. (1) It is hereby declared to be the policy of the general assembly of the2state of Colorado that, in order to safeguard the life, health, and property and the public3welfare of the people of this state and in order to protect the people of this state against4unauthorized, unqualified, and improper practice of chiropractic, it is necessary that a proper5regulatory authority be established and adequately provided for.6

(2) It is unlawful for any person to practice or to offer to practice chiropractic in the7state of Colorado, or to use in connection with his OR HER name or business or otherwise to8assume, use, or advertise any title or description which THAT will or which THAT reasonably9

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might be expected to mislead the public into believing he OR SHE is a doctor of chiropractic,1unless such THE person has been duly licensed under the provisions of this article 215.2Anyone who holds himself OR HERSELF out to the public as a doctor of chiropractic without3qualifying for proper licensing under this article 215 and without submitting to the4regulations provided in this article 215 endangers thereby the public life, health, property,5and welfare.6

712-215-102. Applicability of common provisions. ARTICLES 1, 20, AND 30 OF THIS8

TITLE 12 APPLY, ACCORDING TO THEIR TERMS, TO THIS ARTICLE 215.910

12-215-103. [Formerly 12-33-102] Definitions. As used in this article 33 215,11unless the context otherwise requires:12

(1) "Acupuncture" means the puncture of the skin with fine needles for diagnostic13and therapeutic purposes.14

(1.3) (2) (a) "Animal chiropractic" means diagnosing and treating animal vertebral15subluxation through chiropractic adjustment of the spine or extremity articulations of fully16awake dogs and equids. The chiropractic adjustment may be performed only with the hands17or with the use of a handheld low-force mechanical adjusting device functionally equivalent18to the device known as an activator; all other equipment is prohibited.19

(b) "Animal chiropractic" does not include:20(I) Performing veterinary medical care and diagnosis;21(II) Performing surgery;22(III) Dispensing or administering medications, dietary or nutritional supplements,23

herbs, essences, nutraceutical products, or anything else supplied orally, rectally, by24inhalation, by injection, or topically except topically applied heat or cold;25

(IV) Generating radiographic images or performing imaging procedures, including26thermography;27

(V) Performing acupuncture, or any treatment activity other than chiropractic28adjustment;29

(VI) Providing magnetic or other nonmanual treatment techniques, colonics,30colored-light therapy, homeopathy, radionics, or vitamin therapy;31

(VII) Venipuncture;32(VIII) Making diagnoses by methods such as live cell analysis, pendulum divining,33

iridology, hair analysis, nutritional deficiencyquestionnaires, herbal crystallization analysis,34or food allergy testing.35

(1.5) (3) "Animal vertebral subluxation" means a lesion or dysfunction in a joint or36motion segment in which alignment, movement integrity, or physiological function are37altered, although contact between joint surfaces remains intact, which THAT may influence38biomechanical and neural integrity. Diagnosis of animal vertebral subluxation typically39

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involves evaluation of gait and radiographs, and static and motion palpation techniques that1are used to identify joint dysfunction. Diagnosis of animal vertebral subluxation does not2include methods such as applied kinesiology, reflexology, pendulum divining, or3thermography.4

(1.7) (4) "Chiropractic" means that branch of the healing arts that is based on the5premise that disease is attributable to the abnormal functioning of the human nervous6system. It includes the diagnosing and analyzing of human ailments and seeks the7elimination of the abnormal functioning of the human nervous system by the adjustment or8manipulation, by hand or instrument, of the articulations and adjacent tissue of the human9body, particularly the spinal column, and the use as indicated of procedures that facilitate10the adjustment or manipulation and make it more effective and the use of sanitary, hygienic,11nutritional, and physical remedial measures for the promotion, maintenance, and restoration12of health, the prevention of disease, and the treatment of human ailments. "Chiropractic"13includes the use of venipuncture for diagnostic purposes. "Chiropractic" does not include14colonic irrigation therapy. "Chiropractic" includes treatment byacupuncture when performed15by an appropriately trained chiropractor as determined by the Colorado state board of16chiropractic examiners. Nothing in this section shall apply to persons using acupuncture not17licensed by the board.18

(2) (5) "Chiropractic adjustment" means the application, by hand, by a trained19chiropractor who has fulfilled the educational and licensing requirements of this article 215,20of adjustive force to correct subluxations, fixations, structural distortions, abnormal tensions,21and disrelated structures, or to remove interference with the transmission of nerve force. The22application of the dynamic adjustive thrust is designed and intended to produce and usually23elicits audible and perceptible release of tensions and movement of tissues or anatomical24parts for the purpose of removing or correcting interference to nerve transmission and25expression.26

(3) (6) "Electrotherapy" means the application of any radiant or current energies of27high or low frequency, alternating or direct, except surgical cauterization,28electrocoagulation, the use of radium in any form, and X-ray therapy.29

(3.1) (7) "Equid" means a hoofed mammal of the family equidae and includes30donkeys, horses, mules, and zebras.31

(3.5) (8) "Licensed veterinarian" has the same meaning as set forth in section3212-64-103 (9) 12-315-___(__).33

(4) (9) "Venipuncture" means the puncture of a vein for the withdrawal of blood for34the purpose of diagnosis through blood analysis. Any blood analysis shall be done by a35chiropractor or by a commercial laboratory.36

(5) (10) "Veterinary medical clearance" means that a veterinarian licensed under37article 64 315 of this title 12 has examined an animal patient, has provided a diagnosis or38differential diagnosis if appropriate, and has provided written clearance, which may be39

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transmitted electronically, for animal chiropractic. The veterinary medical clearance shall1precede the commencement of animal chiropractic treatment and may contain limitations on2the scope, date of initiation, and duration of chiropractic treatment. Once a veterinary3medical clearance has been received, the chiropractor is responsible for developing the plan4of care for the animal patient's animal chiropractic.5

612-215-104. State board of chiropractic examiners - subject to termination -7

repeal of article - board meetings - election of officers. (1) [Formerly 12-33-1038(1)] There is hereby created a Colorado state board of chiropractic examiners, referred to9in this article 215 as the "board", consisting of seven members who are citizens of the United10States, five of whom must have practiced chiropractic in the state of Colorado for five years11before their appointment and two of whom shall be appointed from the public at large. The12governor shall appoint members of the board for a term of four years. Any board member13may be removed by the governor for misconduct, incompetence, or neglect of duty. No14member shall serve more than two consecutive terms.15

(2) Repealed.16(3) (2) [Formerly 12-33-103 (3)] (a) The provisions of section 24-34-104 C.R.S.,17

concerning the termination schedule for regulatory bodies of the state unless extended as18provided in that section, are applicable to the Colorado state board of chiropractic examiners19created by this section.20

(b) This article 215 is repealed, effective July 1, 2020.21(3) [Formerly 12-33-105] The board shall elect from the membership thereof a22

president, a vice-president, and a secretary-treasurer. The board shall meet at such times and23at such places as the board deems necessary, but in no case less than annually. A majority24of the board shall constitute a quorum. An annual election of officers shall occur.25

2612-215-104. Oath. (Repealed)27

2812-33-105. Board meetings - election of officers. The board shall elect from the29

membership thereof a president, a vice-president, and a secretary-treasurer. The board shall30meet at such times and at such places as the board deems necessary, but in no case less than31annually. A majority of the board shall constitute a quorum. An annual election of officers32shall occur. <{Moved to 12-215-104 (3), above.}>33

3412-33-106. Bond. (Repealed)35

3612-215-105. Board powers - limits on authority - publications - records.37

(1) [Formerly 12-33-107(1)] The board is authorized to and shall:38(a) Adopt, promulgate, and from time to time revise such rules and regulations not39

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inconsistent with the law as may be necessary to enable it to carry out the provisions of this1article 215; except that the board shall not adopt the code of ethics of any professional group2or association by rule or regulation; <{Recommend striking first portion of paragraph (a)3as redundant with general rule-making authority common provision, 12-20-204.4Recommend moving the "except that" clause to new subsection (2), below.}>5

(b) (a) Examine, license, and renew licenses of dulyqualified chiropractic applicants;6(c) (b) Approve or refuse to approve chiropractic schools and colleges;7(d) (c) Conduct hearings IN ACCORDANCE WITH SECTION 12-20-403 upon complaints8

concerning the disciplining of chiropractors; <{Recommend adding reference to9disciplinary procedures common provision, 12-20-403.}>10

(e) (d) Cause the prosecution of and seek injunctions IN ACCORDANCE WITH SECTION1112-20-406 against all persons violating this article 215; <{Recommend adding reference12to injunctive relief common provision, 12-20-406.}>13

(f) (e) Employ investigators; issue subpoenas, compel the attendance of witnesses,14compel the production of records, books, papers, and documents, and administer oaths to15persons giving testimony at hearings; <{With the exception of the authority to "employ16investigators", the remainder of this provision is redundant with disciplinary procedures17common provision, 12-20-403. Recommend amending as indicated.}>18

(g) Repealed.19(h) (f) Identify and proscribe, by rule, chiropractic practices which THAT are untrue,20

deceptive, or misleading.21(2) THE BOARD SHALL NOT ADOPT THE CODE OF ETHICS OF ANY PROFESSIONAL GROUP22

OR ASSOCIATION BY RULE.23(3) [Formerly 12-33-107.5] The authority granted the board under the provisions24

of this article 215 shall not be construed to authorize the board to arbitrate or adjudicate fee25disputes between licensees or between a licensee and any other party.26

(4) [Formerly 12-33-108 (2)] Publications of the board circulated in quantityoutside27the executive branch shall be issued in accordance with the provisions of section 24-1-136.28C.R.S.29

(5) [Formerly 12-33-110] The board shall keep a record of its proceedings and a30register of all applications for licensing and all licensed chiropractors, such to be public31records and prima facie evidence of the proceedings of the board set forth therein.32

3312-33-107.5. Limitation on authority. The authority granted the board under the34

provisions of this article shall not be construed to authorize the board to arbitrate or35adjudicate fee disputes between licensees or between a licensee and any other party.36<{Moved to 12-215-105 (3), above.}>37

3812-33-108. Board publications.39

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(1) Repealed.1(2) Publications of the board circulated in quantityoutside the executive branch shall2

be issued in accordance with the provisions of section 24-1-136, C.R.S. <{Moved to312-215-105 (4), above.}>4

512-33-109. Disposition of fees. All examination and renewal fees under this article6

215 shall be collected by the board and transmitted to the state treasurer pursuant to law.7<{Redundant with fees common provision, 12-20-105. Recommend repealing.}>8

912-33-110. Records. The board shall keep a record of its proceedings and a register10

of all applications for licensing and all licensed chiropractors, such to be public records and11prima facie evidence of the proceedings of the board set forth therein. <{Moved to1212-215-105 (5), above.}>13

1412-215-106. [Formerly 12-33-111] Licensure - minimum education15

requirements. (1) (a) A minimum educational requirement shall include a knowledge of16the basic sciences and for original licensure shall include graduation from a high school or17its educational equivalent and graduation from an approved chiropractic school or college18which THAT teaches a course of not less than four thousand resident classroom hours in a19period of four academic years. All applicants for licensure who matriculate in a chiropractic20school or college shall present evidence of having graduated from a chiropractic school or21college having status with the commission on accreditation of the council on chiropractic22education, or its successor, or from a chiropractic school or college which THAT meets23equivalent standards. The schedule of minimum educational requirements to enable any24person to practice chiropractic in the state of Colorado is, except as otherwise provided, as25follows:26Group 1. Anatomy, including embryology and histology27Group 2. Physiology and psychology28Group 3. Biochemistry, inorganic and organic chemistry29Group 4. Pathology, bacteriology, and toxicology30Group 5. Public health, hygiene, sanitation, and first aid31Group 6. Diagnosis (to include, but not be limited to, physical, clinical, laboratory, and32all other recognized diagnostic procedures), pediatrics, dermatology, syphilology, psychiatry,33and X ray34Group 7. Obstetrics, gynecology35Group 8. Principles and practice of chiropractic, adjustive technic. Electives including36dietetics, nutrition, posture, physiotherapy, electrotherapy, and surgical, optometric, and37dental indications38

(b) (2) Any chiropractic college or school meeting the requirements of this section39

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and the rules and regulations adopted by the board shall be eligible for approval.12

12-215-107. [Formerly 12-33-111.5] Display of license required. Every licensed3practitioner of chiropractic shall conspicuously display his or her license to practice in this4state. If a chiropractor practices at several locations, his or her name and license number5shall be displayed in a manner that can be easily recognized by patients. Persons who engage6in the practice of chiropractic under the name of a partnership, association, or other entity7shall conspicuously display at the entrance of their place of business the name of each8member or associate of such THE entity who is engaged in the practice of chiropractic.9

1012-215-108. [Formerly 12-33-112] Application for license - fee - examination.11

Anyperson who fulfills the minimum educational requirements prescribed by this article 21512and by the board, who is not less than twenty-one years of age, who desires to obtain a13license to practice chiropractic in this state, and who is not entitled to a license therefor14under other provisions of this article 215 may make application for such A license upon such15THE forms and in such THE manner as prescribed by the board, which application shall be16accompanied by an examination fee. The board may refuse to examine or license an17applicant if the applicant has committed any act that would be grounds for disciplinary18action against a licensed chiropractor. Such THE applicant shall be examined by the board19or the board's designee in the subjects outlined in section 12-33-111 12-215-106 to20determine the applicant's qualifications to practice chiropractic. A license shall be granted21to all applicants who on such THE examination are found qualified by attaining a passing22grade on the examinations adopted by the board. Qualification in that portion of the23examination relating to the basic sciences shall be established by the applicant submitting24proof satisfactory to the board of successfully passing the examination in the basic sciences25given by the National Board of Chiropractic Examiners. The board may adopt the practical26examination developed and administered by the National Board of Chiropractic Examiners27as the practical portion of the examination. If the board adopts such THE practical28examination developed and administered by the National Board of Chiropractic Examiners,29qualification in the practical portion of the examination shall be established by the applicant30submitting proof satisfactory to the board of successfully passing the practical examination31given by the National Board of Chiropractic Examiners, and the passing score for such THE32practical examination shall be as set by the National Board of Chiropractic Examiners. Any33chiropractic applicant who desires to practice electrotherapy shall present evidence that he34or she has successfully completed a course of not less than one hundred twenty classroom35hours in this subject at a school approved by the board or under the instruction of an36approved provider.37

3812-33-112.5 Temporary licensure. (Repealed)39

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12-215-109. [Formerly 12-33-113] Licensure by endorsement. (1) Upon1application for a license to practice chiropractic in this state, accompanied by the required2fee, the board shall issue such A license to any person who furnishes, upon such THE form3and in such THE manner as the board prescribes, evidence satisfactory to the board that:4

(a) The applicant is licensed to practice chiropractic in another state, a territory of the5United States, the District of Columbia, the commonwealth of Puerto Rico, or a province of6Canada; and7

(b) At the time of application under this section, the applicant possesses credentials8and qualifications that are, in the judgment of the board, equivalent to this state's9requirements for licensure by examination; and10

(c) (I) The applicant has been engaged in the full-time practice of chiropractic, or has11taught general clinical chiropractic subjects at an accredited school of chiropractic, as set12forth in section 12-33-111 (1)(a) 12-215-106 (1), in one of the jurisdictions referred to in13paragraph (a) of this subsection (1) SUBSECTION (1)(a) OF THIS SECTION for at least three of14the five years immediately preceding the date of the receipt of the application; or15

(II) The applicant has demonstrated competency as a chiropractor as determined by16the board; and17

(d) The applicant has not been convicted of a crime that would be grounds for the18refusal, suspension, or revocation of a license to practice chiropractic in this state if19committed in this state; and20

(e) The applicant's license to practice chiropractic is in good standing.2122

12-215-110. [Formerly 12-33-114] Renewal of license. (1) Licenses shall be23renewed or reinstated pursuant to a schedule established by the director of the division of24professions and occupations within the department of regulatory agencies and shall be25renewed or reinstated pursuant to section 24-34-102 (8). C.R.S. The director of the division26of professions and occupations within the department of regulatory agencies may establish27renewal fees and delinquency fees for reinstatement pursuant to section 24-34-105. C.R.S.28If a person fails to renew his or her license pursuant to the schedule established by the29director of the division of professions and occupations, such license shall expire ARE30SUBJECT TO THE RENEWAL, EXPIRATION, REINSTATEMENT, AND DELINQUENCY FEE31PROVISIONS OF SECTION 12-20-202 (1) AND (2). Any person whose license has expired shall32be subject to the penalties provided in this article 215 or section 24-34-102 (8). C.R.S.3312-20-202 (1).34

(1.2) (Deleted by amendment, L. 2004, p. 1824, § 64, effective August 4, 2004.)35(1.3) (2) A renewal fee paid pursuant to subsection (1) of this section SECTION36

12-20-202 (1) shall not be refunded.37(2) (Deleted by amendment, L. 2004, p. 1824, § 64, effective August 4, 2004.)38

<{Redundant with renewal/reinstatement common provision, 12-20-202. Recommend39

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amending as indicated.}>12

12-215-111. [Formerly 12-33-114.5] Change of address - reporting required.3Each person licensed under this article 215, upon changing his or her address, shall inform4the board of their THE new address within thirty days after such THE change. The address5change shall be reflected on the next license or renewal certificate issued to the licensee.6

712-215-112. [Formerly 12-33-115] Persons licensed under previous laws. Any8

person holding a valid license to practice chiropractic in Colorado on or after May 18, 1959,9shall be licensed under the provisions of this article 215 without further application by said10THE person.11

1212-215-113. [Formerly 12-33-116] Continuing education. It is hereby expressly13

declared to be the purpose of this section to provide for an increase in the annual scientific14educational requirements of licensed Colorado chiropractors. Each licensed Colorado15chiropractor in active practice within the state of Colorado shall be required annually to16attend not less than fifteen hours of scientific clinics, forums, or chiropractic educational17study consisting of subjects basic to the field of the healing arts as set forth in section1812-33-111 12-215-106. Each year at the time of its regular June meeting, the board shall19prepare an educational schedule of minimum postgraduate requirements of subjects as set20forth in section 12-33-111 12-215-106 that shall be met by any school, clinic, forum, or21convention giving such THE educational work, and such THE minimum standards must be22complied with by such THE school, clinic, forum, or convention before the board issues a23postgraduate attendance certificate. Credit hours shall be determined by the board.24Applicants shall apply to the board prior to or after the course and present proof of25attendance and synopsis of the course content for approval of credit hours. This provision26is made mandatory in the best interest of public health and welfare and to provide progress27in the field of chiropractic. If any licensed chiropractor is unable to comply with this section28on account of dire emergency and for good cause shown, the board may waive the29provisions of this section.30

3112-215-114. [Formerly 12-33-116.5] Professional liability insurance required.32

(1) (a) It is unlawful for any person to practice chiropractic within this state unless the33person purchases and maintains professional liability insurance in an amount not less than34three hundred thousand dollars per claim with an aggregate liability limit for all claims35during the year of one million dollars.36

(b) Professional liability insurance required by this section shall cover all acts within37the scope of practice as defined by section 12-33-102 12-215-103. Professional liability38coverage shall cover acupuncture and electrotherapy only if the licensee is authorized to39

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perform these acts.1(2) Notwithstanding subsection (1) of this section, the board may by rule exempt or2

establish lesser liability insurance requirements for any class of licensee which THAT:3(a) Practices chiropractic as employees of the United States government;4(b) Renders limited or occasional chiropractic services;5(c) Performs less than full-time active chiropractic services because of administrative6

or other nonclinical duties of partial or complete retirement;7(d) Provides uncompensated chiropractic care to patients but does not otherwise8

provide compensated chiropractic care to patients; or9(e) Practices chiropractic in such a manner that renders the amounts provided in10

subsection (1) of this section unreasonable or unattainable.1112

12-215-115. [Formerly 12-33-117] Discipline of licensees - letters of admonition,13suspension, revocation, denial, and probation - grounds. (1) Upon any of the following14grounds, the board may issue a letter of admonition to a licensee or may revoke, suspend,15deny, refuse to renew, TAKE DISCIPLINARY OR OTHER ACTION AS SPECIFIED IN SECTION1612-20-404 or impose conditions on such A licensee's license: <{Redundant with17disciplinary authority common provisions, 12-20-404. Recommend amending as18indicated.}>19

(a) Using fraud, misrepresentation, or deceit in applying for, securing, renewing, or20seeking reinstatement of a license or in taking an examination provided for in this article21215;22

(b) An act or omission that constitutes negligent chiropractic practice or fails to meet23generally accepted standards of chiropractic practice;24

(c) Conviction of a felony or any crime that would constitute a violation of this25article 215. For purposes of this subsection (1), "conviction" includes the acceptance of a26guilty plea or a plea of nolo contendere or the imposition of a deferred sentence.27

(d) A substance use disorder, as defined in section 27-82-102, or excessive use by28the licensee of a controlled substance, as defined in section 18-18-102 (5), or a29habit-forming drug;30

(e) An alcohol use disorder, as defined in section 27-81-102, or excessive use of31alcohol by the licensee;32

(f) Disobedience to a lawful rule or order of the board;33(g) Persisting in maintaining an unsanitary office or practicing under unsanitary34

conditions after warning from the board;35(h) Repealed.36(i) (h) False or misleading advertising;37(j) (i) Failure to report malpractice judgments or settlements within sixty days;38(k) (j) Violation of abuse of health insurance pursuant to section 18-13-119 C.R.S.,39

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or commission of a fraudulent insurance act, as defined in section 10-1-128; C.R.S.;1(l) (k) Treating a patient by colonic irrigation or allowing colonic irrigation to be2

performed at the licensee's premises;3(m) (l) Practicing with a suspended or expired license;4(n) (m) Willfully deceiving or attempting to deceive the board of examiners or their5

ITS agents with reference to any matter under investigation by the board;6(o) (n) Practicing under an assumed name;7(p) (o) Unethical advertising, as defined in subsection (3) (4) of this section, or8

advertising through any medium that the licensee will perform an act prohibited by section918-13-119 (3); C.R.S.;10

(q) (p) Violating this article 215 or aiding any person to violate this article 215;11(r) (q) Knowingly practicing in the employment of or in association with any person12

who is practicing in an unlawful or unprofessional manner;13(s) (r) Offering, giving, or receiving commissions, rebates, or other forms of14

remuneration for the referral of clients; except that a licensee may compensate an15independent advisory or marketing agent for advertising or marketing services, which16services may include the referral of patients identified through such THE services, and a17licensee may give an incidental gift to a patient in appreciation for a referral;18

(t) (s) Conducting any enterprise other than the regular practice of chiropractic19whereby the holder's license is used as a means of attracting patients or attaining prestige or20patronage in the conduct of such THE enterprise;21

(u) (t) Permitting the practice of chiropractic, the holding out of such THE practice,22or the maintenance of an office for such THE PRACTICE by an unlicensed person in23association with himself or herself;24

(v) (u) Engaging in anyof the following activities and practices: Willful and repeated25ordering or performance, without clinical justification, of demonstrably unnecessary26laboratory tests or studies; the administration, without clinical justification, of treatment27which THAT is demonstrably unnecessary; the failure to obtain consultations or perform28referrals when failing to do so is not consistent with the standard of care for the profession;29or ordering or performing, without clinical justification, any service, X ray, or treatment30which THAT is contrary to recognized standards of the practice of chiropractic as interpreted31by the board;32

(w) (v) Falsifying or making incorrect essential entries or failing to make essential33entries on patient records;34

(x) (w) Violating section 8-42-101 (3.6); C.R.S.;35(y) (x) Violating section 12-33-202 12-215-202 or any rule adopted pursuant to said36

THAT section;37(z) (y) Failing to report to the board the surrender of a license to, or adverse action38

taken against a license by, a licensing agency in another state, territory, or country, a39

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governmental agency, a law enforcement agency, or a court for acts or conduct that would1constitute grounds for discipline pursuant to this article 215;2

(aa) (z) Engaging in a sexual act with a patient during the course of such THE3patient's care or within six months immediately following the termination of the4chiropractor's professional relationship with the patient. "Sexual act", as used in this5paragraph (aa) SUBSECTION (1)(z), means sexual contact, sexual intrusion, or sexual6penetration, as defined in section 18-3-401. C.R.S.7

(bb) (aa) Abandoning a patient by any means, including, but not limited to, failing8to provide a referral to another chiropractor or other appropriate health care practitioner9when such THE referral was necessary to meet generally accepted standards of chiropractic10care;11

(cc) (bb) Failing to provide adequate or proper supervision when employing12unlicensed persons in a chiropractic practice;13

(dd) (cc) Having a physical or mental disability that makes him or her unable to14render chiropractic services with reasonable skill and safety;15

(ee) (dd) Performing a procedure in the course of patient care that is beyond the16chiropractor's training or competence or the scope of authorized chiropractic services under17this article 215;18

(ff) (ee) Failing to respond to a board-generated complaint letter.19(1.5) (2) In addition to any other penalty that may be imposed pursuant to this20

section, a chiropractor violating any provision of this article 215 or any rule promulgated21pursuant to this article 215 OR SECTION 12-20-204 may be fined no less than one thousand22dollars for a first violation proven by the board, up to three thousand dollars for a second23violation proven by the board, and up to five thousand dollars for a third or subsequent24violation proven by the board. The board shall establish guidelines for the imposition of25such THE fines. All fines collected pursuant to this subsection (1.5) shall be transferred to26the state treasurer, who shall credit such moneys to the general fund. <{Recommend striking27last sentence as redundant with disposition of fines common provision, 12-20-404 (6).}>28<{Also recommend adding reference to general rule-making authority common29provision, 12-20-204, since recommend repealing the corresponding general language30in 12-215-105 (1), above.}>31

(2) (3) Disciplinaryaction taken against a licensee's ability to practice in another state32or country shall be prima facie evidence of a violation of this article 215 and shall constitute33grounds for discipline if the acts giving rise to such THE disciplinary action would violate34this article 215 if committed in this state.35

(2.5) When a complaint or investigation discloses an instance of conduct that does36not warrant formal action by the board and, in the opinion of the board, the complaint should37be dismissed, but the board has noticed indications of possible errant conduct by the licensee38that could lead to serious consequences if not corrected, a confidential letter of concern may39

13

DRAFT10.15.18

be issued and sent to the licensee. <{Redundant with confidential letter of concern1common provisions, 12-20-404 (5). Recommend repealing.}>2

(3) (a) (4) For purposes of this section, the term "unethical advertising" shall include,3but not be limited to, advertising, through newspapers, magazines, circulars, direct mail,4directories, radio, television, or otherwise, which THAT:5

(I) (a) Contains false or misleading statements;6(II) (b) Holds out or promises cures or guarantees results; OR7(III) (c) Contains claims which THAT cannot be substantiated by standard laboratory8

or diagnostic procedures.9(IV) and (V) Repealed.10(b) Repealed.11(4) (5) Any doctor of chiropractic proven to be incompetent or negligent may be12

required to take an examination, given by the board, in the subjects outlined in section1312-33-111 12-215-106. In addition, the board may order the doctor of chiropractic to take14such therapy or courses of training or education as may be needed to correct deficiencies15found in the hearing.16

(5) (6) In the event any person holding a license to practice chiropractic in this state17is determined to be mentally incompetent or insane by a court of competent jurisdiction and18a court enters, pursuant to part 3 or 4 of article 14 of title 15 or section 27-65-109 (4) or1927-65-127, C.R.S., an order specifically finding that the mental incompetency or insanity is20of such a degree that the person holding a license is incapable of continuing to practice21chiropractic, his or her license shall automatically be suspended by the board, and, anything22in this article 215 to the contrary notwithstanding, such THE suspension shall continue until23the licentiate LICENSEE is found by such THE court to be competent to practice chiropractic.24

2512-215-116. [Formerly 12-33-117.5] Mental and physical examination of26

licensees. (1) (a) If the board has reasonable cause to believe a licensee is unable to practice27with reasonable skill and safetyUNDER THE CIRCUMSTANCES AND IN ACCORDANCE WITH THE28PROCEDURES SPECIFIED IN SECTION 12-30-108, THE BOARD may require such A licensee to29take a mental or physical examination given by a physician or other qualified provider30designated by the board. <{Recommend amending as indicated to strike redundant31language and add reference to mental/physical exams common provision, 12-30-108.}>32

(b) If the licensee refuses to undergo such examination or to release all medical33records necessary to determine his or her ability to practice safely, unless such THE refusal34or failure is due to circumstances beyond the licensee's control, the board may suspend such35THE licensee's license until the results of such examination are known and the board has36made a determination of the licensee's fitness to practice. The board shall proceed with an37order for examination and make its determination in a timely manner.38<{The unhighlighted portion of paragraph (b) is consistent with the mental/physical39

14

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exams common provision, 12-30-108 (1)(b). However, the highlighted portion differs1from the common provision in that it allows the board to maintain the license suspension2until the exam results are known and the director has determined the licensee's fitness to3practice. The common provision refers to suspending the license "until the required4examinations are conducted." So the criteria in this practice act for lifting the suspension5differ from the criteria in the common provision. Is this a substantive difference in how6this provision is applied? Additionally, the last sentence about timely making a7determination does not appear in the common provision. We assume that this unique8provision should be retained as is rather than defaulting to the common provision.9Thoughts?}10

(2) An order for examination issued by the board pursuant to subsection (1) of this11section shall include the board's reasons for believing the licensee is unable to practice with12reasonable skill and safety. <{Redundant with mental/physical exams common provision,1312-30-108 (1)(c). Recommend repealing.}>14

(3) For purposes of any disciplinary proceeding authorized under this article, a15licensee shall be deemed to have waived all objections to the admissibility of an examining16physician's testimony and examination reports on the basis of privilege. <{Redundant with17mental/physical exams common provision, 12-30-108 (2), second sentence. Recommend18repealing.}>19<{Note that the common provision, 12-30-108 (2) 1st sentence, also contains the20following language that does NOT appear in this section: "Every nurse LICENSEE,21CERTIFICATE HOLDER, OR REGISTRANT AUTHORIZED TO PRACTICE A HEALTH CARE22PROFESSION REGULATED BY A PART OR ARTICLE OF THIS TITLE 12 shall be deemed, by so23practicing or by applying for renewal registration of such nurse's THE license,24CERTIFICATE, OR REGISTRATION, to have consented to submit to mental or physical25examinations when directed in writing by the board APPLICABLE REGULATOR." Should26this provision be specifically excluded from applicability to chiropractors since it does not27appear in the mental/physical exams provision in the chiropractors practice act?}>28

29<{Note that the common provision, 12-30-108 (2) 3rd sentence, also contains the30following language that does NOT appear in this section: "Subject to applicable federal31law, such nurse THE LICENSEE, CERTIFICATE HOLDER, OR REGISTRANT shall be deemed to32have waived all objections to the production of medical records to the board REGULATOR33from health care providers that may be necessary for the evaluations EXAMINATIONS34described in paragraph (a) of this subsection (8) . . . SUBSECTION (1)(a) OF THIS SECTION."35Should this provision be specifically excluded from applicability to chiropractors since it36does not appear in the mental/physical exams provision in the chiropractors practice37act?}>38

(4) (2) A licensee may submit to the board testimony and examination reports39

15

DRAFT10.15.18

received from a physician chosen by the licensee, if such testimony and reports pertain to1a condition that the board has alleged may preclude the licensee from practicing with2reasonable skill and safety. <{Stricken from mental/physical exams common provision,312-30-108 (2), so recommend retaining this provision.}>4

(5) The results of a mental or physical examination ordered by the board shall not be5used as evidence in any proceeding other than one held before the board and shall not be a6public record nor made available to the public. <{Redundant with mental and physical7examination common provision, section 12-30-108 (3). Recommend repealing.}>8

9<{Need to consider, for the above mental/physical exams provision, if it is so unique that10is warrants complete exclusion from common provision, 12-30-108, and retention of the11existing language in 12-33-117.5.}>12

1312-215-117. [Formerly 12-33-118] Use of title. A license to practice chiropractic14

entitles the holder to use the title "Doctor" or "Dr." when accompanied by the word15"Chiropractor" or the letters "D.C.", and to use the title of "Doctor of Chiropractic". Such16THE license shall not confer upon the licensee the right to practice surgery or obstetrics, or17to prescribe, compound, or administer drugs, or to administer anesthetics. Nothing in this18article 215 shall be construed to prohibit or to require a license for bona fide chiropractic19students or interns in attendance upon a regular course of instruction in a lawfully operated20chiropractic school or hospital with respect to performing chiropractic services within such21THE school or hospital while under the direct supervision of a licensed chiropractor.22

2312-215-118. [Formerly 12-33-119] Disciplinary proceedings. (1) The board,24

through the department of regulatory agencies, may employ administrative law judges, on25a full-time or part-time basis, to conduct hearings as provided by this article 215 or on any26matter within the board's jurisdiction upon such conditions and terms as the board may27determine.28

(2) A proceeding for the discipline of a licensee may be commenced when the board29has reasonable grounds to believe that a licensee under the board's jurisdiction has30committed an act that may violate section 12-33-117 12-215-115.31

(3) The attendance of witnesses and the production of books, patient records, papers,32and other pertinent documents at the hearing may be summoned by subpoenas issued by the33board, which shall be served in the manner provided by the Colorado rules of civil procedure34for service of subpoenas. <{Somewhat redundant with disciplinary procedures/subpoena35powers common provision, 12-20-403 (2)(a). OK to strike?}>36

(3.5) (Deleted by amendment, L. 2004, p. 1825, § 65, effective August 4, 2004.)37(4) (3) Disciplinary proceedings and hearings shall be conducted in the manner38

prescribed by SECTION 12-20-403 AND article 4 of title 24. C.R.S. <{Recommend adding39

16

DRAFT10.15.18

reference to disciplinary procedures common provision, 12-20-403.}>1(5) (4) A previously issued license to engage in the practice of chiropractic shall not2

be revoked or suspended until after a hearing conducted pursuant to section 24-4-105,3C.R.S., except in the case of a deliberate and willful violation of this article 215 or if the4public health, safety, and welfare require emergency action under section 24-4-104 (4).5C.R.S. The denial of an application to renew an existing license shall be treated in all6respects as a revocation. If an application for a new license is denied, the applicant, within7sixty days after the giving of notice of such action, may request a hearing as provided in8section 24-4-105. C.R.S.9

(6) Repealed.10(7) (5) (a) WHEN the board or an administrative law judge shall have the power to11

administer oaths, take affirmations of witnesses, and issue ISSUES subpoenas IN12ACCORDANCE WITH SECTION 12-20-403 (2) to compel the attendance of witnesses and the13production of all relevant papers, books, records, documentary evidence, and materials, in14any hearing, investigation, accusation, or other matter coming before the board. The board15may appoint an administrative law judge pursuant to part 10 of article 30 of title 24, C.R.S.,16to take evidence and to make findings and report them to the board. the person providing17such THE copies shall prepare them from the original record and shall delete from the copy18provided pursuant to the subpoena the name of the patient, but he or she shall identify the19patient by a numbered code, to be retained by the custodian of the records from which the20copies were made. <{Partially redundant with disciplinary procedures/subpoena powers21and appointment of ALJ common provision, 12-20-403 (2)(a) & (3). Recommend22amending as indicated.}>23

(b) Upon certification of the custodian that the copies are true and complete except24for the patient's name, they shall be deemed authentic, subject to the right to subpoena the25originals for the limited purpose of ascertaining the accuracy of the copies. The originals26shall remain confidential and be returned to the custodian as soon as the accuracy of the27copy is ascertained or as soon as the case is concluded if the original is needed as evidence28of falsification. No privilege of confidentiality shall exist with respect to such THE copies,29and no liability shall lie against the board or the custodian for furnishing or using such THE30copies in accordance with this subsection (7) (5).31

(c) Upon failure of any witness to comply with such subpoena or process, the district32court of the county in which the subpoenaed person or licensee resides or conducts business,33upon application by the board or director with notice to the subpoenaed person or licensee,34may issue to the person or licensee an order requiring that person or licensee to appear35before the board or director; to produce the relevant papers, books, records, documentary36evidence, or materials if so ordered; or to give evidence touching the matter under37investigation or in question. Failure to obey the order of the court may be punished by the38court as a contempt of court. <{Redundant with disciplinary procedures/subpoena powers39

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common provision, 12-20-403 (2)(b). Recommend repealing.}>1(8) (6) If a licensee has committed an act which THAT violates section 12-33-1172

12-215-115, the board shall withhold, revoke, or suspend an existing license, issue a letter3of admonition, or grant probation on terms and conditions set by the board, TAKE4DISCIPLINARY OR OTHER ACTION AS SPECIFIED IN SECTION 12-20-404 or otherwise discipline5a licensee as provided for in this article 215. A revoked or suspended license may thereafter6be reissued by the board. The board may dismiss or terminate probation prior to the7completion of the probationary period. <{Redundant with disciplinary action common8provision, 12-20-404. Recommend amending as indicated.}>9

(9) (a) When a complaint or an investigation discloses an instance of misconduct10that, in the opinion of the board, does not warrant formal action by the board but that should11not be dismissed as being without merit, a letter of admonition may be sent by certified mail12to the chiropractor against whom the complaint was made and a copy also sent to the person13making the complaint. When a letter of admonition is sent by certified mail by the board to14a chiropractor complained against, such chiropractor shall be advised that he or she has the15right to request in writing, within twenty days after receipt of the letter, that formal16disciplinary proceedings be initiated to adjudicate the propriety of the conduct upon which17the letter of admonition is based. If such request is timely made, the letter of admonition18shall be deemed vacated, and the matter shall be processed by means of formal disciplinary19proceedings. <{Redundant with letters of admonition common provision, 12-2-404 (4).20Recommend repealing.}>21

(b) When a complaint or an investigation discloses an instance of misconduct that,22in the opinion of the board, warrants formal action, the complaint shall not be resolved by23a deferred settlement, action, judgment, or prosecution. <{Redundant with disciplinary24actions/no deferment common provision, 12-20-404 (2). Recommend repealing.}>25

(10) (7) Notwithstanding other laws to the contrary, investigations, examinations,26meetings, and other proceedings of the board conducted pursuant to this section are not27required to be conducted publically PUBLICLY, and minutes of the board need not be open28to public inspection; except that final action of the board taken pursuant to this section shall29be open to the public.30

3112-215-119. [Formerly 12-33-119.1] Professional review committee - immunity.32

(1) If a professional review committee is established pursuant to this section to investigate33the quality of care, including utilization review, being given by a person licensed pursuant34to this article 215, it shall include in its membership at least three persons licensed under this35article 215, but such committee may be authorized to act only by:36

(a) The board; or37(b) A society or an association of persons licensed pursuant to this article 215 whose38

membership includes not less than one-third of the persons licensed pursuant to this article39

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215 residing in this state if the licensee whose services are the subject of review is a member1of such society or association.2

(2) IN ADDITION TO THE PERSONS SPECIFIED IN SECTION 12-20-402, any member of3the board or A professional review committee, the board's or professional review committee's4staff, AND any person acting as a witness or consultant to the board or committee anywitness5testifying in a proceeding authorized under this article, and any person who lodges a6complaint pursuant to this article shall be immune from liability in any civil action brought7against him or her for acts occurring while acting in his or her capacity as board or8professional review committee member, staff, consultant, or witness, respectively, if such9individual was acting in good faith within the scope of his or her respective capacity, made10a reasonable effort to obtain the facts of the matter as to which he or she acted, and acted in11the reasonable belief that the action taken by him or her was warranted by the facts. Any12person participating in good faith in lodging a complaint or participating in any investigative13or administrative proceeding pursuant to this article shall be immune from any civil or14criminal liability that may result from such participation IS GRANTED THE SAME IMMUNITY,15AND IS SUBJECT TO THE SAME CONDITIONS FOR IMMUNITY, AS SPECIFIED IN SECTION1612-20-402. <{Somewhat redundant with immunity common provision, section 12-20-402.17Recommend amending as indicated.}>18

1912-215-120. [Formerly 12-33-119.2] Cease-and-desist orders. (1) (a) If it appears20

to the board, based upon credible evidence as presented in a written complaint by any21person, that a licensee is acting in a manner that is an imminent threat to the health and22safety of the public or a person is acting or has acted without the required license, the board23may issue an order to cease and desist such activity. The order shall set forth the statutes and24rules alleged to have been violated, the facts alleged to have constituted the violation, and25the requirement that all unlawful acts or unlicensed practices immediately cease.26

(b) Within ten days after service of the order to cease and desist pursuant to27paragraph (a) of this subsection (1), the respondent may request a hearing on the question28of whether acts or practices in violation of this part 1 have occurred. Such hearing shall be29conducted pursuant to sections 24-4-104 and 24-4-105, C.R.S.30

(2) (a) If it appears to the board, based upon credible evidence as presented in a31written complaint by any person, that a person has violated any other portion of this part 1,32then, in addition to any specific powers granted pursuant to this part 1, the board may issue33to such person an order to show cause as to why the board should not issue a final order34directing such person to cease and desist from the unlawful act or unlicensed practice.35

(b) A person against whom an order to show cause has been issued pursuant to36paragraph (a) of this subsection (2) shall be promptly notified by the board of the issuance37of the order, along with a copy of the order, the factual and legal basis for the order, and the38date set by the board for a hearing on the order. Such notice may be served by personal39

19

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service, by first-class United States mail, postage prepaid, or as may be practicable upon any1person against whom such order is issued. Personal service or mailing of an order or2document pursuant to this subsection (2) shall constitute notice thereof to the person.3

(c) (I) The hearing on an order to show cause shall be commenced no sooner than4ten and no later than forty-five calendar days after the date of transmission or service of the5notification by the board as provided in paragraph (b) of this subsection (2). The hearing6may be continued by agreement of all parties based upon the complexity of the matter,7number of parties to the matter, and legal issues presented in the matter, but in no event shall8the hearing commence later than sixty calendar days after the date of transmission or service9of the notification.10

(II) If a person against whom an order to show cause has been issued pursuant to11paragraph (a) of this subsection (2) does not appear at the hearing, the board may present12evidence that notification was properly sent or served upon such person pursuant to13paragraph (b) of this subsection (2) and such other evidence related to the matter as the14board deems appropriate. The board shall issue the order within ten days after the board's15determination related to reasonable attempts to notify the respondent, and the order shall16become final as to that person byoperation of law. Such hearing shall be conducted pursuant17to sections 24-4-104 and 24-4-105, C.R.S.18

(III) If the board reasonably finds that the person against whom the order to show19cause was issued is acting or has acted without the required license or has or is about to20engage in acts or practices constituting violations of this part 1, a final cease-and-desist order21may be issued directing such person to cease and desist from further unlawful acts or22unlicensed practices.23

(IV) The board shall provide notice, in the manner set forth in paragraph (b) of this24subsection (2), of the final cease-and-desist order within ten calendar days after the hearing25conducted pursuant to this paragraph (c) to each person against whom the final order has26been issued. The final order issued pursuant to subparagraph (III) of this paragraph (c) shall27be effective when issued and shall be a final order for purposes of judicial review.28

(3) If it appears to the board, based upon credible evidence presented to the board,29that a person has engaged in or is about to engage in any unlicensed act or practice, any act30or practice constituting a violation of this part 1, any rule promulgated pursuant to this part311, any order issued pursuant to this part 1, or any act or practice constituting grounds for32administrative sanction pursuant to this part 1, the board may enter into a stipulation with33such person.34

(4) If any person fails to comply with a final cease-and-desist order or a stipulation,35the board may request the attorney general or the district attorney for the judicial district in36which the alleged violation exists to bring, and if so requested such attorney shall bring, suit37for a temporary restraining order and for injunctive relief to prevent any further or continued38violation of the final order. <{Subsections (1) through (4) redundant with cease-and-desist39

20

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orders common provision, 12-20-405. Recommend repeal subsections (1) to (4) and1replacing with cross-reference to cease-and-desist orders common provisions, below.}>2

(5) A person aggrieved by the final cease-and-desist order may seek judicial review3of the board's determination or of the board's final order as provided in section 12-33-121.4<{Subsection (5) redundant with judicial review common provision, 12-20-408.5Recommend repealing.}>6

THE BOARD MAY ISSUE CEASE-AND-DESIST ORDERS UNDER THE CIRCUMSTANCES AND7IN ACCORDANCE THE PROCEDURES SPECIFIED IN SECTION 12-20-405.8

912-215-121. [Formerly 12-33-120] Unauthorized practice - penalties -10

exemption. (1) Except as specified in subsection (2) or (3) of this section, any person who11practices or offers or attempts to practice chiropractic without an active license issued under12this article commits a class 2 misdemeanor and shall be punished as provided in section1318-1.3-501 C.R.S., for the first offense, and, for the second or any subsequent offense, the14person commits a class 6 felony and shall be punished as provided in section 18-1.3-401.15C.R.S. 215 IS SUBJECTTO PENALTIES PURSUANT TO SECTION12-20-407 (1)(a). <{Redundant16with unauthorized practice common provision, 12-20-407. Recommend amending as17indicated.}>18

(2) A chiropractor who lawfully practices chiropractic in another state or territory19and whose license is in good standing in such THE other state or territory may practice20chiropractic in this state for the limited purpose of treating members, coaches, and staff of21a visiting sports team while in Colorado without having a license issued pursuant to this22article 215. An unlicensed chiropractor practicing pursuant to this subsection (2) shall not:23

(a) Practice in Colorado more than ten days in a twelve-month period;24(b) Enter Colorado to practice more than three times in a twelve-month period; or25(c) Hold himself or herself out as a chiropractor to or practice chiropractic with26

members of the general public.27(3) A chiropractor who lawfully practices chiropractic in another state or territory28

may provide chiropractic services to athletes or team personnel registered to train at the29United States Olympic training center in Colorado Springs or to provide chiropractic30services at an event in this state sanctioned by the United States Olympic committee. The31chiropractor's services shall be contingent upon the requirements and approvals of the32United States Olympic committee and shall not exceed ninety days per calendar year.33

3412-215-122. [Formerly 12-33-121] Judicial review. The court of appeals shall35

have initial jurisdiction to SECTION 12-20-408 GOVERNS JUDICIAL review all final actions36and orders OF THE BOARD that are subject to judicial review. of the board. Such proceeding37shall be conducted in accordance with section 24-4-106 (11). C.R.S. <{Redundant with38judicial review common provision, 12-20-408. Recommend amending as indicated.}>39

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12-215-123. [Formerly 12-33-122] Duty of district attorneys - duty of1department of regulatory agencies. It is the duty of the several district attorneys of this2state to prosecute all persons charged with the violation of any of the provisions of this3article 215. It is the duty of the secretary-treasurer of the board, under the direction of the4board, to aid said attorneys in the enforcement of this article 215. It is the duty of the5attorney general to advise the board upon all legal matters and to represent the board in all6actions brought by or against it. It is the duty of the department of regulatory agencies to7forward to the board a copy of any correspondence concerning the professional conduct or8competence of any licensed chiropractor which THAT the department either transmits or9receives.10

1112-33-123. Application of article. (Repealed)12

1312-215-124. [Formerly 12-33-124] Professional service corporations, limited14

liability companies, and registered limited liability partnerships for the practice of15chiropractic - definitions. (1) Persons licensed to practice chiropractic by the board may16form professional service corporations for the practice of chiropractic under the "Colorado17Corporation Code", if such THE corporations are organized and operated in accordance with18the provisions of this section. The articles of incorporation of such THE corporations shall19contain provisions complying with the following requirements:20

(a) The name of the corporation shall contain the words "professional company" or21"professional corporation" or abbreviations thereof.22

(b) The corporation shall be organized solely for the purposes of conducting the23practice of chiropractic only through persons licensed by the board to practice chiropractic24in the state of Colorado.25

(c) The corporation may exercise the powers and privileges conferred upon26corporations by the laws of Colorado only in furtherance of and subject to its corporate27purpose.28

(d) All shareholders of the corporation shall be persons licensed by the board to29practice chiropractic in the state of Colorado, and who at all times own their shares in their30own right. They shall be individuals who, except for illness, accident, time spent in the31armed services, on vacations, and on leaves of absence not to exceed one year, are actively32engaged in the practice of chiropractic in the offices of the corporation.33

(e) Provisions shall be made requiring any shareholder who ceases to be or for any34reason is ineligible to be a shareholder to dispose of all his OR HER shares forthwith, either35to the corporation or to any person having the qualifications described in paragraph (d) of36this subsection (1) SUBSECTION (1)(d) OF THIS SECTION.37

(f) The president shall be a shareholder and a director, and to the extent possible, all38other directors and officers shall be persons having the qualifications described in paragraph39

22

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(d) of this subsection (1) SUBSECTION (1)(d) OF THIS SECTION. Lay directors and officers1shall not exercise any authority whatsoever over professional matters.2

(g) The articles of incorporation shall provide, and all shareholders of the corporation3shall agree, that all shareholders of the corporation shall be jointly and severally liable for4all acts, errors, and omissions of the employees of the corporation, or that all shareholders5of the corporation shall be jointly and severally liable for all acts, errors, and omissions of6the employees of the corporation except during periods of time when the corporation7maintains in good standing professional liability insurance which THAT shall meet the8following minimum standards:9

(I) The insurance shall insure the corporation against liability imposed upon the10corporation by law for damages resulting from any claim made against the corporation11arising out of the performance of professional services for others by those officers and12employees of the corporation who are licensed by the board to practice chiropractic.13

(II) Such THE policies shall insure the corporation against liability imposed upon it14by law for damages arising out of the acts, errors, and omissions of all nonprofessional15employees.16

(III) The insurance shall be in an amount for each claim of at least fifty thousand17dollars multiplied by the number of persons licensed to practice chiropractic employed by18the corporation. The policy may provide for an aggregate top limit of liability per year for19all claims of one hundred fifty thousand dollars also multiplied by the number of persons20licensed to practice chiropractic employed by the corporation, but no firm shall be required21to carry insurance in excess of three hundred thousand dollars for each claim with an22aggregate top limit of liability for all claims during the year of nine hundred thousand23dollars.24

(IV) The policy may provide that it does not apply to: Any dishonest, fraudulent,25criminal, or malicious act or omission of the insured corporation or any stockholder or26employee thereof; the conduct of any business enterprise, as distinguished from the practice27of chiropractic, in which the insured corporation under this section is not permitted to28engage but which THAT nevertheless may be owned by the insured corporation or in which29the insured corporation may be a partner or which THAT may be controlled, operated, or30managed by the insured corporation in its own or in a fiduciary capacity, including the31ownership, maintenance, or use of any property in connection therewith; when not resulting32from breach of professional duty, bodily injury to, or sickness, disease, or death of any33person, or to injury to or destruction of any tangible property, including the loss of use34thereof; and such THE policy may contain reasonable provisions with respect to policy35periods, territory, claims, conditions, and other usual matters.36

(2) Repealed.37(3) (2) The corporation shall do nothing which THAT, if done by a person licensed38

to practice chiropractic in the state of Colorado employed by it, would violate the standards39

23

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of professional conduct as provided for in section 12-33-117 12-215-115. Any violation by1the corporation of this section shall be grounds for the board to terminate or suspend its right2to practice chiropractic.3

(4) (3) Nothing in this section shall be deemed to diminish or change the obligation4of each person licensed to practice chiropractic employed by the corporation to conduct his5OR HER practice in accordance with the standards of professional conduct provided for in6section 12-33-117 12-215-115. Any person licensed by the board to practice chiropractic7who by act or omission causes the corporation to act or fail to act in a way which THAT8violates such THE standards of professional conduct, including any provision of this section,9shall be deemed personally responsible for such THE act or omission and shall be subject to10discipline therefor.11

(5) (4) A professional service corporation may adopt a pension, CASH OR DEFERRED12profit-sharing, (whether cash or deferred) health and accident insurance, or welfare plan for13all or part of its employees including lay employees if such THE plan does not require or14result in the sharing of specific or identifiable fees with lay employees, and if any payments15made to lay employees, or into any such plan in behalf of lay employees, are based upon16their compensation or length of service, or both, rather than the amount of fees or income17received.18

(6) (5) Except as provided in this section, corporations shall not practice chiropractic.19(7) (6) As used in this section, unless the context otherwise requires:20(a) "Articles of incorporation" includes operating agreements of limited liability21

companies and partnership agreements of registered limited liability partnerships.22(b) "Corporation" includes a limited liabilitycompanyorganized under the "Colorado23

Limited Liability Company Act", article 80 of title 7, C.R.S., and a limited liability24partnership registered under section 7-60-144 or 7-64-1002. C.R.S.25

(c) "Director" and "officer" of a corporation includes a member and a manager of a26limited liability company and a partner in a registered limited liability partnership.27

(d) "Employees" includes employees, members, and managers of a limited liability28company and employees and partners of a registered limited liability partnership.29

(e) "Share" includes a member's rights in a limited liability company and a partner's30rights in a registered limited liability partnership.31

(f) "Shareholder" includes a member of a limited liability company and a partner in32a registered limited liability partnership.33

3412-215-125. [Formerly 12-33-125] Reporting requirements. A person licensed35

to practice chiropractic in this state shall report to the board any chiropractor known or36believed to have violated this article 215.37

3812-215-126. [Formerly 12-33-126] Confidentiality - exceptions. (1) A licensee39

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shall not disclose confidential communications made between such THE licensee and a1patient in the course of such THE licensee's professional employment unless such THE patient2gives his or her consent prior to the disclosure. An employee or associate of a licensee shall3not disclose any knowledge of confidential communications acquired in his or her capacity4as an employee or associate, unless a patient gives his or her consent prior to the disclosure.5

(2) Subsection (1) of this section shall not apply when:6(a) A patient or an heir, executor, or administrator of a patient files a complaint or7

suit against a licensee with respect to any cause of action arising out of or connected with:8(I) The care or treatment of such THE patient by such THE licensee; or9(II) The consultation by such THE licensee with another health care practitioner who10

provided care or treatment to the patient.11(b) A review of the services of a licensee is conducted by:12(I) The board, or a person or group authorized by the board;13(II) The governing board of a hospital where said THE licensee practices, which14

hospital is licensed pursuant to part 1 of article 3 of title 25, C.R.S., or the medical staff of15such THE hospital if said THE staff operates pursuant to written bylaws approved by the16governing board of the hospital; or17

(III) A professional review committee established pursuant to section 12-33-119.11812-215-119, if the licensee has signed a release authorizing such THE review.19

(3) The records and information produced and used in a review described in20paragraph (b) of subsection (2) SUBSECTION (2)(b) of this section shall not become public21records solely because of the use of such THE records and information in such THE review,22and the identity of a patient whose records are reviewed pursuant to said paragraph23SUBSECTION (2)(b) OF THIS SECTION shall not be disclosed to any person not directly24involved in the review process. The board shall adopt procedures to ensure that the identity25of patients remains confidential during the review process.26

(4) Nothing in this section shall be deemed to prohibit any disclosure required by27law.28

2912-215-127. [Formerly 12-33-127] Animal chiropractic - registration -30

qualifications - continuing education - collaboration with veterinarian - discipline - title31restriction - rules. (1) (a) A licensed chiropractor who is registered under this section is32authorized to perform animal chiropractic when the chiropractic diagnosis and treatment is33consistent with the scope of practice for chiropractors and the licensed chiropractor performs34animal chiropractic in accordance with all state and local requirements regarding animal35licensing and vaccinations, including compliance with part 6 of article 4 of title 25 and36section 30-15-101. A chiropractor must have the knowledge, skill, ability, and documented37competency to perform an act that is within the scope of practice for chiropractors.38

(b) In recognition of the special authority granted by this section, the performance39

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of animal chiropractic in accordance with this section shall not be deemed a violation of1section 12-64-104 12-315-____ .2

(c) A licensed chiropractor who is not registered under this section may perform3animal chiropractic if performed under the direct, on-premises supervision of a licensed4veterinarian.5

(d) An individual who is not licensed as a chiropractor or a veterinarian may not6perform animal chiropractic.7

(2) The state board of chiropractic examiners shall regulate animal chiropractic and8diagnosis, including, without limitation, educational and clinical requirements for the9performance of animal chiropractic and the procedure for referring complaints to the10department of regulatory agencies regarding animal chiropractic diagnosis and11therapy.<{Since this section also refers to the veterinary board, I thought we should retain12reference to the full chiro board name for clarity. Thoughts?}>13

(3) Registry. (a) The state board of chiropractic examiners shall maintain a database14of all licensed chiropractors that WHO are registered pursuant to this section and rules15promulgated pursuant to this article 215 <{Should the rule-making be limited to "this16section"?}> to practice animal chiropractic in this state. Information in the database shall17be open to public inspection at all times and shall be easily accessible in electronic form.18

(b) A licensed chiropractor who chooses to practice animal chiropractic and who19seeks registration in animal chiropractic shall provide the state board of chiropractic20examiners with registration information as required by the board, which shall include the21chiropractor's name, current address, education and training in the field of animal22chiropractic, active Colorado chiropractic license, and qualifications to perform animal23chiropractic and treatment. Forms for chiropractors to provide such THIS information shall24be provided by the board.25

(4) Educational qualifications. A licensed chiropractor who seeks registration in26animal chiropractic must obtain education in the field of animal chiropractic from an27accredited college of veterinary medicine, an accredited college of chiropractic, or an28educational program deemed equivalent by mutual agreement of the state board of29chiropractic examiners and the state board of veterinary medicine. The educational program30must consist of no fewer than two hundred ten hours, include both classroom instruction and31clinical experience, and culminate with a proficiency evaluation. The educational program32must include the following subjects:33

(a) Chiropractic topics, including:34(I) History and systems review;35(II) Subluxation and vertebral subluxation; and36(III) Adjustment techniques for dogs and equids;37(b) Veterinary topics specific to dogs and equids, including:38(I) Anatomy, including sacropelvic, thoracolumbar, cervical, and extremity,39

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including normal hoof anatomy and care;1(II) Physiology;2(III) Behavior;3(IV) Knowledge of breed anomalies;4(V) Restraint;5(VI) Biomechanics, gait, and lameness;6(VII) Neurology, neuroanatomy, and neurological conditions;7(VIII) Differential diagnosis of neuromusculoskeletal conditions;8(IX) Motion palpation;9(X) Pathology; and10(XI) Radiographic interpretation;11(c) Recognition of dog and equid zoonotic and contagious diseases;12(d) Animal-specific case management, outcome assessment, and documentation; and13(e) Animal-specific professional ethics and legalities.14(4.5) (5) One-time education requirements. (a) A licensed chiropractor who is15

registered to perform animal chiropractic or who applies to be registered to perform animal16chiropractic shall successfully complete the following one-time courses:17

(I) A one-hour jurisprudence course that includes information about statutes, rules,18and procedures concerning notification requirements governing the identification of19contagious, infectious, and zoonotic diseases; and20

(II) An eight-hour course on contagious, infectious, and zoonotic diseases that covers21recognition of early indicators and clinical signs of the following diseases:22

(A) In dog patients: Rabies virus; West Nile virus; canine brucellosis, also known23as brucella canis; plague, also known as yersinia pestis; and tularemia, also known as24francisella tularensis; and25

(B) In equid patients: Rabies virus; West Nile virus; and equine herpesvirus26myeloencephalopathy.27

(b) For each of the diseases listed in subsection (4.5)(a)(II) (5)(a)(II) of this section,28the course must address:29

(I) Pathology;30(II) Clinical presentation;31(III) Biosecurity issues;32(IV) Public health concerns in Colorado; and33(V) Herd health concerns in Colorado.34(c) After a licensed chiropractor has successfully completed the jurisprudence and35

contagious, infectious, and zoonotic diseases courses required under this subsection (4.5)36(5), he or she need not take the courses again as a condition of registration renewal or37reinstatement.38

(d) Until a licensed chiropractor successfully completes the courses required under39

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this subsection (4.5) (5), the licensed chiropractor must obtain veterinary medical clearance1from a licensed veterinarian to perform animal chiropractic.2

(5) (6) Continuing education. (a) A licensed chiropractor who is registered to3perform animal chiropractic shall complete twenty hours of continuing education per4licensing period that is specific to the diagnosis and treatment of animals. All continuing5education courses must be in the fields of study listed in subsections (4) and (4.5) (5) of this6section.7

(b) On and after November 1, 2019, the twenty hours of continuing education8required under this subsection (5) (6) must include a two-hour course on contagious,9infectious, and zoonotic diseases, including current information about the incidence rates10of rabies virus, West Nile virus, equine herpesvirus myeloencephalopathy, canine11brucellosis, plague, and tularemia in Colorado and in other locations that might affect a12licensed chiropractor's animal patients.13

(5.5) (7) Initiation of treatment notification and reporting requirements.14(a) Within seven business days after initiating treatment of an animal patient, a licensed15chiropractor registered to perform animal chiropractic must notify the animal patient's16veterinarian of the initiation of treatment if a licensed veterinarian is treating the animal17patient. If the animal patient is not being treated by a licensed veterinarian, the licensed18chiropractor may satisfy this subsection (5.5)(a) (7)(a) by providing the individual who19brought in the animal patient with a written summary of the treatment performed or20anticipated to be performed, which written summarymaybe kept with anyhealth documents21maintained for the animal patient.22

(b) If, before, during, or after performing animal chiropractic on an animal patient,23a licensed chiropractor suspects that the animal patient:24

(I) Has a reportable disease, as defined in section 35-50-103, the licensed25chiropractor shall immediately report the disease to the state veterinarian and, if the animal26patient is being treated by a licensed veterinarian, to the animal patient's licensed27veterinarian; or28

(II) Has potentially had contact with a rabies reservoir species; has indicators of29canine brucellosis, plague, tularemia, or other indicators of a contagious, infectious, or30zoonotic disease; or exhibits ataxia, paralysis, proprioceptive deficit, or incontinence that31might be a result of a contagious, infectious, or zoonotic disease, the licensed chiropractor32shall:33

(A) Immediately decline or stop performing chiropractic adjustment on the animal34patient;35

(B) Immediately notify the state veterinarian and the animal patient's licensed36veterinarian or, if the animal patient is not being treated by a licensed veterinarian, notify37only the state veterinarian, of the suspected contact, indicators, or exhibited condition; and38

(C) Delay any further chiropractic adjustment until disease can be ruled out or the39

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chiropractor, in collaboration with the animal patient's licensed veterinarian or the state1veterinarian, determines appropriate actions to prevent the spread of the contagious,2infectious, or zoonotic disease.3

(c) Any licensed chiropractor who, in good faith and in the normal course of4business, reports his or her suspicion of disease pursuant to subsection (5.5)(b) (7)(b) of this5section is immune from liability in any civil or criminal action brought against the licensed6chiropractor for reporting.7

(6) (8) Records and professional collaboration. (a) A licensed veterinarian who8provides veterinary medical clearance for animal chiropractic may require a veterinarian's9presence at anychiropractic treatment rendered pursuant to the veterinarymedical clearance.10

(b) The chiropractor and the veterinarian shall continue professional collaboration11as necessary for the well-being of the animal patient. The veterinarian shall provide the12animal patient's medical record to the chiropractor upon request.13

(c) The chiropractor shall maintain an animal patient record that includes the written14veterinary medical clearance, if clearance was required, including the name of the licensed15veterinarian, date, and time the clearance was received. The chiropractor shall furnish a copy16of the medical record to the licensed veterinarian upon the licensed veterinarian's request.17

(d) A licensed chiropractor registered to perform animal chiropractic shall maintain18complete and accurate records or patient files in the chiropractor's office for a minimum of19three years.20

(7) (9) Discipline. Complaints received in the office of the state board of chiropractic21examiners that include allegations of a violation related to animal chiropractic shall be22forwarded to the state board of veterinary medicine for its review and advisory23recommendation to the state board of chiropractic examiners. The state board of chiropractic24examiners retains the final authority for decisions related to the discipline of a chiropractor.25

(8) (10) Separate treatment room. A licensed chiropractor who provides animal26chiropractic diagnosis and treatment in the same facility where human patients are treated27shall maintain a separate, noncarpeted room for the purpose of adjusting animals. The table28and equipment used for animals shall not be used for human patients.29

(9) (11) Use of title. Only a licensed chiropractor qualified and registered in30Colorado to perform animal chiropractic may use the titles "animal chiropractor", "animal31adjuster", "equine chiropractor", or "equine adjuster". No chiropractor shall use the titles32"veterinary chiropractor" or "veterinary adjuster" unless the chiropractor is also licensed to33practice veterinary medicine in Colorado. Nothing in this section shall prohibit a licensed34veterinarian from using the titles "animal adjuster" or "equine adjuster".35

(10) (12) Rules. The state board of chiropractic examiners, in consultation with the36state board of veterinary medicine, may establish by rule any additional requirements to be37met by a chiropractor regarding required documentation and any other rules necessary for38the implementation of this section.39

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(11) (12) Nothing in this section shall be construed to prohibit, limit, or alter the1privileges or practices of any other licensed profession, including veterinarians, from2performing spinal, extremity, or other aspects of adjustment, manipulation, or mobilization3on animals as allowed for in the scope of their respective practice acts.4

512-215-128. [Formerly 12-33-128] Chiropractic assistants. A chiropractor may6

supervise up to five unlicensed persons as chiropractic assistants if such THE UNLICENSED7persons have received appropriate training as established by the board by rule promulgated8pursuant to section 12-33-107 12-20-204. A chiropractic assistant may perform his or her9duties only under the direct supervision of a chiropractor and only in those areas in which10the chiropractic assistant has the requisite skill and training. A chiropractic assistant shall11not perform a diagnosis, an adjustment, or acupuncture. <{Since we are proposing to strike12the general rule-making authority in current sec. 12-33-107 as covered by the general13rule-making authority common provision, 12-20-204, we recommend referring to the14common provision in this section.}>15

16PART 217

SAFETY TRAINING FOR UNLICENSED X-RAY TECHNICIANS1819

12-215-201. [Formerly 12-33-201] Legislative declaration. (1) The general20assembly hereby finds, determines, and declares that public exposure to the hazards of21ionizing radiation used for diagnostic purposes should be minimized wherever possible.22Accordingly, the general assembly finds, determines, and declares that for any licensed23chiropractor to allow an untrained person to operate a machine source of ionizing radiation,24including without limitation a device commonly known as an "X-ray machine", or to25administer such radiation to a patient for diagnostic purposes is a threat to the public health26and safety.27

(2) It is the intent of the general assembly that licensed chiropractors utilizing28unlicensed persons in their practices provide those persons with a minimum level of29education and training before allowing them to operate machine sources of ionizing30radiation; however, it is not the general assembly's intent to discourage education and31training beyond this minimum. It is further the intent of the general assembly that established32minimum training and education requirements correspond as closely as possible to the33requirements of each particular work setting as determined by the Colorado state board of34chiropractic examiners pursuant to this part 2.35

(3) The general assembly seeks to ensure, and accordingly declares its intent, that in36promulgating the rules and regulations authorized by this part 2, the board will make every37effort, consistent with its other statutory duties, to avoid creating a shortage of qualified38individuals to operate machine sources of ionizing radiation for beneficial medical purposes39

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in any area of the state.12

12-215-202. [Formerly 12-33-202] Board authorized to issue rules - definition.3(1) (a) The Colorado state board of chiropractic examiners shall adopt rules and regulations4prescribing minimum standards for the qualifications, education, and training of unlicensed5persons operating machine sources of ionizing radiation and administering such radiation6to patients for diagnostic chiropractic use. No licensed chiropractor shall allow any7unlicensed person to operate any machine source of ionizing radiation or to administer such8radiation to any patient unless such THE person has met the standards then in effect under9rules and regulations adopted pursuant to this section. The board may adopt rules and10regulations allowing a grace period in which newly hired operators of machine sources of11ionizing radiation shall receive the training required pursuant to this section.12

(b) For purposes of this part 2, "unlicensed person" means any person who does not13hold a current and active license entitling the person to practice chiropractic under the14provisions of this article 215.15

(2) The board shall seek the assistance of licensed chiropractors in developing and16formulating the rules and regulations promulgated pursuant to this section.17

(3) The required number of hours of training and education for all unlicensed18persons operating machine sources of ionizing radiation and administering such radiation19to patients shall be established by the board by rule on or before July 1, 1992. This standard20shall apply to all persons in chiropractic settings other than hospitals and similar facilities21licensed by the department of public health and environment pursuant to section 25-1.5-103.22C.R.S. Such THE training and education maybe obtained through programs approved by the23appropriate authority of any state or through equivalent programs and training experience24including on-the-job training as determined by the board. <{OK to strike date?}>25

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